Contract agencies can obtain pamphlets, forms and posters by contacting CYS QRT at cysqrt@ochca.com or calling 714-796-0123.

Clinical Information

• BHS Formulary
• Client Intake Questionnaire
• CYS Medication Consents
  • English
  • Farsi  MS Word 
  • Korean  MS Word
  • Spanish
  • Vietnamese
• CYS Prescribing Practices
• 2013 Annual Provider Training - Forms/Resources/Notes 
• EPSDT Documentation Manual

• Included-Excluded-Diagnoses Included-Excluded Diagnosis(pdf)
• JV-220A-prescribing-physician-statement, JV-220A (form fillable)
• Legal Classes and Court Conservator Status
• Service Strategies
• Treatment Authorization Request (TAR)

Medi-Cal Information (For Distribution to Consumers )

• Behavioral Health Services Directory

Mental Health Provider List

• English
• Farsi
• Spanish
• Vietnamese

Mental Health Plan Intake/Advisement Checklist

• English
• Farsi
• Spanish
• Vietnamese

Guide to Mental Health Services

• English
• Farsi
• Spanish
• Vietnamese

Audio Version (English, Farsi, Spanish, Vietnamese)

Advanced Health Care Directives

• English
• Farsi
• Spanish
• Vietnamese

Grievance Appeal Form

• English
• Farsi
• Spanish
• Vietnamese

Notice of Action-A

• Notice of Action Policy and Procedures (Includes NOA-A English version)
• Mandarin Chinese NOA-A
• Korean NOA-A
• Spanish NOA-A
• Vietnamese NOA-A

HIPAA

• Authorization to Use and Disclose Protected Health Information
• Authorization to Use and Disclose Protected Health Information (Spanish version)
• Revocation of Authorization to Use or Disclose Public Health Information (form fillable)

FAQs

• Revised Encounter Document FAQ 1-9-2013
• MD Encounter Document FAQ 2-21-2013